Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome

Abstract

The aim of this study is to compare the effect of phonophoresis, ultrasound and placebo ultrasound therapies in the treatment of myofascial pain syndrome (MPS). This is a randomized, double-blind placebo controlled study. Sixty patients (48 women, 12 men, mean age 37.9 ± 12.2 years) with MPS were included in this study. Patients were allocated into three groups. Group 1(n = 20) was received diclofenac phonophoresis, group 2(n = 20) was received ultrasound and group 3(n = 20) was received placebo ultrasound therapies over trigger points, 10 min a day for 15 session during 3 weeks (1 MHz-1,5 watt/cm2). Additionally, all patients were given neck exercise program including isotonic, isometric and stretching. Patients were assessed by means of pain, range of motion (ROM) of neck, number of trigger points (NTP), algometric measurement and disability. Pain severity was measured by visual analog scale (VAS) and Likert scale. The neck pain disability index (NPDI) was used for assessing disability. Measurements were taken before and after treatment. After treatment, there were statistically significant improvements in pain severity, NTP, pressure pain threshold (PPT), ROM and NPDI scores both in phonophoresis and in ultrasound therapy groups (P < 0.05). Statistically significant increase in cervical lateral flexion and rotation was observed in the placebo US group. While there was no statistically significant improvement in the cervical flexion–extension joint movement, pain levels, number of trigger points and NPDI score, pressure pain threshold (P > 0.05), also there were no significant differences in all parameters between group 1 and 2 (P = 0.05). Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS. Phonophoresis was not found to be superior over ultrasound therapy.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Lavelle ED, Lavelle WL, Smith HS (2007) Myofascial trigger points. Med Clin N Am 91:229–239

    PubMed  Article  Google Scholar 

  2. 2.

    Testa M, Barbero M, Gherlone E (2003) Trigger points: update of the clinical aspects. Eur Med Phys 39:37–43

    Google Scholar 

  3. 3.

    Srbely JZ, Dickey JP (2007) Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy? Clin Rehabil 21:411–417

    PubMed  Article  Google Scholar 

  4. 4.

    Simons DG (1988) Myofascial pain syndromes: where are we? Where are we going? Arch Phys Med Rehabil 69:207–212

    PubMed  CAS  Google Scholar 

  5. 5.

    Wals NE, Dumitru D, Schoenfeld LS, DeLisa JA (2005) Treatment of the patient with chronic pain. In: DeLisa JA, Gans B (eds) Physical medicine & rehabilitation principles and practice. Lippincott Williams &Wilkins, Philadelphia, pp 493–529

    Google Scholar 

  6. 6.

    Machet L, Boucaud A (2002) Phonophoresis: efficiency, mechanisms and skin tolerance. Int J Pharm 243:1–15

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Windt D, Heijden G, Berg S, Riet G, Winter A, Bouter L (1999) Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 81:257–271

    PubMed  Article  Google Scholar 

  8. 8.

    Gam AN, Warning S, Larsen LH, Jensen B, Hoydalsmo O, Allon I et al (1998) Treatment of myofascial trigger—points with ultrasound combined with massage and exercise a randomised controlled trial. Pain 77:73–79

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Robertson VJ, Baker KG (2001) A review of therapeutic ultrasound: effectiveness studies. Phys Ther 81:1339–1350

    PubMed  CAS  Google Scholar 

  10. 10.

    Byl NN (1995) The use of ultrasound as an enhancer for transcutaneous drug delivery: phonophoresis. Phys Ther 75:539–553

    PubMed  CAS  Google Scholar 

  11. 11.

    Simons DG (1990) Muscular pain syndrome. In: Friction JR, Awad EA (eds) Advances in pain research and therapy. Raven Press, New York, pp 1–41

    Google Scholar 

  12. 12.

    Wolfe F, Smyte HA, Yunus MD, Bennett RM (1990) American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum 33:160–172

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Bicer A, Yazici A, Camdeviren H, Erdogan C (2004) Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. Disabil Rehabil 26:959–962

    PubMed  Article  Google Scholar 

  14. 14.

    Kozanoglu E, Basaran S, Güzel R, Uysal F (2003) Short term efficacy of ibuprofen phonophoresis versus continuous ultrasound therapy in knee osteoarthritis. Swiss Med Wkly 133:333–338

    PubMed  CAS  Google Scholar 

  15. 15.

    Hoppenrath T, Ciccone CD (2006) Is there evidence that phonophoresis is more effective than ultrasound in treating pain associated with lateral epicondylitis. Phys Ther 86:136–140

    PubMed  Google Scholar 

  16. 16.

    Basford JR (2005) Therapeutic physical agents. In: DeLisa JA, Gans B (eds) Physical medicine & rehabilitation principles and practice. Lippincott Williams &Wilkins, Philadelphia, pp 251–270

    Google Scholar 

  17. 17.

    Weber DC, Brown AW (2000) Physical agent modalities. In: Braddom RL (ed) Physical medicine & rehabilitation. WB Saunders, Philadelphia, pp 440–458

    Google Scholar 

  18. 18.

    Klaiman MD, Shrader JA, Danoff JV, Hicks JE, Pesce WJ, Ferland J (1998) Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions. Med Sci Sports Exerc 30:1349–1355

    PubMed  CAS  Google Scholar 

  19. 19.

    Shin SM, Choi JK (1997) Effect of indomethacin phonophoresis on the relief of temporomandibular joint pain. Cranio 15:345–348

    PubMed  CAS  Google Scholar 

  20. 20.

    Hsieh YL (2006) Effects of ultrasound and dicofenac phonophoresis on inflammatory pain relief: suppression of inducible nitric oxide synthase in arthritic rats. Phys Ther 86:39–49

    PubMed  Google Scholar 

  21. 21.

    Esenyel M, Caglar N, Aldemir T (2000) Treatment of myofascial pain. Am J Phys Med Rehabil 79:48–52

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Cummings M, Baldry P (2007) Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol 21:367–387

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Saime Ay.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ay, S., Doğan, Ş.K., Evcik, D. et al. Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int 31, 1203–1208 (2011). https://doi.org/10.1007/s00296-010-1419-0

Download citation

Keywords

  • Myofascial pain syndrome
  • Phonophoresis
  • Ultrasound